Needs and conflicts are increasing, and resources available to assist the most vulnerable populations recorded a record decline of 10% in 2024 compared to the previous year. In 2025, the numbers will be much worse, and with them will come an increase in deaths that can only be seen now.
“In the coming months we expect malnutrition, epidemiological crises, etc.,” Raquel Ayora, Director General of Médecins Sans Frontières in Spain, predicted on Wednesday, when presenting the report. “We can now collectively wake up because the health crises will worsen, we will have to respond quickly and we have doubts about whether the system will be able to do this. Next year, without a doubt, we will be counting deaths.” Humanitarian action in 2024-2025: a system in crisis, between cuts, the search for legitimacy and the need for urgent reformsImplemented by MSF and the Institute for Studies in Conflict and Humanitarian Action (IECAH).
In 2024, the reduction in humanitarian aid funds reached $5 billion (4,284 million euros) and the total volume reached 46.1 billion (39.5 billion euros), according to data from this research. “There has been the largest decline in humanitarian funding since these reports emerged, and the data we have for 2025 is even more disappointing, because as of the end of September, the decline has already exceeded 30%,” said Francisco Rey, co-director of the International Humanitarian Aid Agency.
Our data for 2025 is even more disappointing because as of the end of September, the decline has already exceeded 30%.
Francisco Rey, Co-Director of IECAH
This is mainly due to cuts in the United States, where the cooperation agency, USAID, which until a few months ago was responsible for, but not only, 43% of the money that the world’s governments allocate to development aid has been dismantled. Of the total humanitarian aid recorded in 2024, the United States, European Union institutions, Germany and the United Kingdom contributed 65% of this amount. Of these four donors, only the European Union will keep its humanitarian and development budgets stable until 2027.
Jesús A. said: Nunes, co-director of IECAH: “The issue has a name of its own: Donald Trump, the obstructive leader, the anti-democratic leader. We are facing an enlightened personality and any candidate, whether called the United Nations or international humanitarian law, disturbs him because he takes away his room for maneuver. He breaks this international order and takes us into the law of the jungle.”
Now we can collectively wake up because health crises will worsen, and we will have to respond quickly
Raquel Ayora, Director General of Médecins Sans Frontières
Deaths due to malnutrition or malaria
According to the report, essential programs to prevent and treat malaria, HIV, tuberculosis or malnutrition, and sexual and reproductive health services, have already been severely affected.
In Somalia, for example, reduced funding has led to the closure of dozens of health structures, and deaths from malnutrition or malaria have already begun to increase, a disease that in 2023 will cause the death of nearly 600,000 people in the world.
“In the Democratic Republic of the Congo, cuts have led to the dismantling of part of the care provided to survivors of sexual violence, and at the same time, there has been a serious increase in violence against women due to the intensification of the conflict,” said Ayora, from MSF in Spain. “The circumstances have converged.” According to the person in charge, this battle is “not only about financial priorities, but also about ideology,” with women’s reproductive rights at its heart.
“The fact that we are a target of the Trump administration shows how important what we do is and that is why we have been highlighted,” Ayora added.
The report’s authors estimate that the response to these cuts has been what is called a “humanitarian reset,” that is, better coordination, diversification of funding and resource seeking, and “hyperprioritization” or limiting what gets done or who gets treated and who doesn’t.
At the beginning of October 2025, only 21.1% of UN humanitarian appeals were covered, equivalent to $9.56 billion out of the $45.34 billion requested, while global military expenditures recorded an unprecedented increase and reached $2.72 trillion at the end of 2024. In addition to the lack of resources, the humanitarian system is also suffering from a loss of effectiveness and legitimacy and is in dire need of reform.
In Spain, the trajectory is considered “positive” and net official development assistance increased by 11% in 2024 compared to the previous year and amounted to just over 4,000 million euros. Despite this increase, the funds are equivalent to 0.25% of GDP, a far cry from the 0.7% commitment that the government aspires to achieve by 2030. Of this total, €174 million has been allocated to humanitarian aid, which implies a setback. “This is partly because the ‘Ukraine effect’ that led to the surge has ended and has only been partially replaced by the ‘Gaza effect,’” the officials said.
Gaza, Ukraine and Sudan
As of 2024, Palestine is the largest recipient of humanitarian aid funds, totaling $2.9 billion (51% more than in 2023). On the other hand, Ukraine suffered a decline of about 25% (from $3.7 billion to $2.8 billion), while funding for Syria decreased from $3.5 billion in 2023 to $1.7 billion in 2024.
Once again, Ukraine, Gaza and Sudan are the most representative scenarios of “protracted and disproportionate violence,” as this report highlights. “There is practically no red line that Israel has not crossed,” its authors criticize.
“Ukraine has reached the limits of its capabilities, and has no room to maneuver to change the situation, while Russia, despite the failure of its military strategy, retains the will and means to move forward indefinitely,” Nunez summed up.
In Sudan, where conflict between the government army led by Abdel Fattah al-Burhan and the paramilitary Rapid Support Forces has been ongoing since April 2023, there are nearly 12 million displaced people, and the country is experiencing the worst humanitarian crisis in decades. “No one has an interest in stopping this,” Ayura lamented. He added, “The level of violence and the inability to mobilize public opinion and political actors in confronting this situation is unprecedented.”
The authors of the report highlighted that, according to the Global Peace Index 2025 of the Institute for Economics and Peace, there are 59 active violent conflicts in different parts of the planet at this time, although the attention of the authorities and the media is often focused on a few of them, which implies “a reduction in diplomatic and financial effort to address the remaining crises and conflicts.”
For Gaza’s hospitals, this translates into impossible decisions, like which child to put on a ventilator. These are decisions we make every day. This is not management, but survival.
Ruth Conde, pediatric nurse at MSF
Hospital bombing
MSF officials believe it is necessary to address the increasingly frequent attacks against medical and humanitarian missions and highlight “the growing role of government actors as the main perpetrators and the high price paid by local staff.”
“Years ago, the hospital bombing was a unique case,” Ayora said, recalling that when the United States attacked the Doctors Without Borders hospital in Kunduz (Afghanistan), in which more than 40 people were killed, President Barack Obama publicly apologized. “But then came Syria, South Sudan, Sudan and Gaza,” Ayora added. “Gaza really represents a turning point in the history of humanitarian work. It meant breaking all norms. When not one hospital, but 30 hospitals are bombed, we end up assuming that this is an acceptable way to wage war.”
When not one hospital is bombed, but 30, we eventually assume that this is an acceptable way to wage war.
Raquel Ayora, Director General of Médecins Sans Frontières
Officials from Doctors Without Borders and the International Humanitarian Aid Committee also considered that in Gaza now “it appears that the war is over and the conflict will continue as it was until October 7, 2023,” when the Palestinian Islamist movement Hamas carried out attacks in Israel in which about 1,250 people were killed and began the bombing of Gaza, which continued for two years and led to the deaths of at least 70,000 Palestinians.
“A ceasefire is not enough,” explained Ruth Conde, an MSF pediatric nurse who had just returned from the Strip. “The population must have access to housing, drinking water, medicine and decent living conditions.”
This health care provider said that there is basic medical equipment that Israel has kept at the gates of Gaza for months, such as “wheelchairs, crutches or small generators,” which Israel considers may have military uses.
He concluded, “For Gaza’s hospitals, this translates into impossible decisions, such as deciding which child to put on a ventilator. These are decisions we make every day. This is not management, but survival.”